Wednesday, November 7, 2012

Internal Medicine Day 2: I made sense of this rotation?

So I think I've finally figured out how internal medicine works.
 So in the end, all the patients in the hospital get divided up among the students with interns and residents looking over everything.

Yea... its a shitstorm.


Every morning at 7am, all the students, interns (aka 1st year residents), residents, and the chief resident gather in the cafeteria where Dr. L who is the attending in charge in the morning conducts "table rounds". Basically we go through the whole list of patients and the people who were covering patient care overnight summarize each patients illness, and what was done for them overnight and if there were any major changes. Dr. L likes to give mini lectures based on each patient and is an amazing teacher. He is like freaking Dr. House, he thinks of all these crazy other diseases we could test for just for the learning experience, and has great pearls of wisdom on even the everyday things like pneumonia and sepsis.
After this, the residents meet briefly with their interns while the students grab breakfast. Then after breakfast the intern meets with his students and tells us the plan for each of our patients and gives us things to do for them.

Now we are basically on our own until noon. We take this time to go see our patients (average patient load per student is usually between 2-4), make sure their labs are ordered/done, and write up their chart/discharge summaries. If they need any procedures done, we get to do them, or if we don't know how, we bug our intern to show us.


Usually around noon we either have another lecture, or we have "grand rounds" where we walk around to each patients bed, and the student makes a formal presentation of the patients case and what we are doing for them. This can take awhile especially because the attending in the afternoon, Dr. P, likes to "pimp" us: aka grill us on our medical knowledge.

An example:
-Student: "Mr. Smith is an 80 year old male presenting with pneumonia and ...."
-Dr. P: "stop. What is the most likely pathogen causing community aquired pneumonia in this aged patient? How about nosicomial pneumonia?"


And so on....

After "Grand Rounds" and subsequent crying hysterically in the supply closet/lunch, we are again left to our own devices to either continue catching up on paperwork/patient care, or go study in the library.

At 4pm sharp, the whole group again convenes to go over the whole list of patients to decide what needs to be done overnight for every patient, and the responsibilities are handed off to the residents/interns/students who were assigned overnight duty that night.

Then we are free!!! And that's a typical day on Internal Medicine. I'll have patient stories tomorrow, promise.